Drugged Driving: A Serious Public Safety Threat National Association of Drug Court Professionals Robert L. Du. Pont, M. D. , President Institute for Behavior and Health, Inc. www. ibhinc. org www. Stop. Drugged. Driving. org
Qualifications and Disclosures 1968: Started career in District of Columbia Department of Corrections 1970: Founded Narcotics Treatment Administration 1973 to 1977: Second White House Drug Chief 1973 to 1978: Founding Director, National Institute on Drug Abuse 1978 to Present: President, Institute for Behavior and Health, Inc. 1980 to Present: Clinical Professor of Psychiatry, Georgetown Medical School 1982 to Present: Co-founder and Executive Vice President, Bensinger, Du. Pont & Associates; Chairman, Prescription Drug Research Center (subsidiary of BDA)
Presentation Today Introduction to drugged driving Prevalence of the drugged driving problem National policy efforts to reduce drugged driving Defining a drugged driving violation Drug testing needs Linking drugged drivers to treatment Next steps for drugged driving
The Problem Drugged Driving refers to operating a vehicle after the use of impairing substances which may include: Illegal drugs Misused prescription drugs (with and without prescriptions) Over-the-counter medications Other chemicals (e. g. inhaling aerosol spray) Drug Court participants, as well as returning veterans, many of whom face co-occurring diagnoses and addiction issues, are prime candidates for arrests for drugged driving
A Growing National Focus Drugged driving is an under-recognized highway safety problem, particularly among the public Dedicated leadership has elevated drugged driving to the national stage in the United States, including the Office of National Drug Control Policy and National Highway Traffic Safety Administration
Turning Points December 2009 release of data from the 2007 National Roadside Survey 2010 National Drug Control Strategy identified reducing drugged driving by 10% by 2015 as a national priority; reaffirmed in 2011 and 2012 in the National Strategy The National Institute on Drug Abuse has led by promoting a new generation of policy-relevant drugged driving research NIDA’s 2011 Drugged Driving Research: A White Paper Leadership from National Association of Drug Court Professionals (NADCP), National Transportation Safety Board (NTSB), and Mothers Against Drunk Driving (MADD) (ONDCP 2010; 2011 a; 2011 b; 2012)
Drugs Impair Driving Examples of the dangerous effects of drugs on driving include: Disorientation, poor judgment/decision-making, changes in reaction time, distance estimation, concentration, impulse control Many factors influence the effects of a drug on a driver and can be enhanced by drug-drug interactions, including alcohol Drug use triples the risk of fatal crash; a combination of drugs and alcohol produces 23 times the risk of fatal crash (Couper & Logan, 2004; Li, Brady & Chen, 2013)
Drugged Driving Research Decades of research on alcohol and driving, now with other drugs Significant prevalence of drugs among driver populations: National surveys (self-report and random stops) Impaired driving (DUI) suspects Seriously injured drivers Fatally injured drivers There is much more research than the studies reviewed in this presentation (Du. Pont, et al. , 2011)
Driving Under the Influence 29. 1 million (11. 2%) drivers aged 12 and older report that they drove under the influence of alcohol in the previous year 10. 3 million (3. 9%) report driving under the influence of illicit drugs But among randomly stopped drivers, impaired driving suspects, and seriously and fatally injured drivers, we see that drugged driving is roughly equal to the problem of drunk driving (SAMHSA, 2013)
National Roadside Survey: Drug Use Among Weekend Nighttime Drivers 16. 3% of drivers were positive for potentially impairing drugs Most common illegal drugs: Cannabis, 8. 6% Cocaine, 3. 9% Methamphetamine, 1. 3% (Lacey, et al. , 2009)
NRS: Alcohol Use Among Weekend Nighttime Drivers 12. 4% of drivers were alcoholpositive Illegal Blood Alcohol Concentrations (BAC) of 0. 08 g/d. L or higher steadily decreased during this time (Compton & Berning, 2009)
Crash-Involved Drivers Taken to Shock-Trauma Half were positive for illegal drugs One third positive for alcohol One quarter positive for both illegal drug(s) and alcohol One quarter positive for marijuana; 39% of marijuana-positive drivers were also positive for another drug (Walsh, et al. , 2005)
Impaired Driving Suspects A US study of impaired driving suspects showed that 31% positive for drugs 86% positive for alcohol 25% positive for both 51% of drivers with BACs below 0. 08 were drugpositive 22% of drivers with illegal BACs were drug-positive (Buchan, et al. , 1998; Fix, et al. , 1997)
Fatally Injured Drivers Research shows that the while the prevalence of alcohol among fatally injured drivers decreased from 2005 to 2009, the prevalence of drugs among dead drivers increased 18% In 2009, one third (33%) of all fatally injured drivers in the U. S. who had confirmed drug test results (n=12, 055) were drug-positive 28% of drug-positive drivers tested positive for marijuana (NHTSA, 2010)
Drug Prevalence Among Fatally Injured Drivers Has Increased, 2005 -2009 34% 33% 32% 31% 30% 29% 28% 28% 2005 (n=12, 324) 2006 (n=14, 325) 2007 (n=14, 893) 28% 27% 26% 25% 2008 (n=14, 381) 2009 (n=12, 055) (Center for Substance Abuse Research, 2010)
Fatally Injured Drivers With national fatally injured driver data we are only seeing a part of the picture Only 20 states test at least 80% of fatally injured drivers for drugs Testing procedures and panels are not standardized Some states do not test for marijuana Research has shown that drug-involved crashes occur throughout the day while alcohol crashes are more common at night (Romano & Pollini, 2013)
Fatally Injured Drivers In a study of fatally injured drivers in Washington State (n=370), 39% were positive for drugs 12. 7% were positive for marijuana 41% of all drivers were positive for alcohol Of all alcohol-positive cases, 42% were also positive for one or more drug showing the overlap in drug and alcohol use among drivers (Schwilke, Sampaio dos Santos, & Logan, 2006)
Drugged Driving Policy and Demand Reduction Strong, effective drugged driving laws and comprehensive enforcement are crucial elements of improved demand reduction Reducing drugged driving is part of the solution to: 1) Prevent illegal drug use 2) Promote highway safety 3) Deliver substance abusers to treatment with the leverage to help them become and stay drug-free
Drugged Driving Laws 1) Per se drug laws 2) Impairment laws 3) Administrative license revocation (ALR) Drugged driving laws cannot follow same path as alcohol-impaired driving laws
Alcohol Impairment Standard Reducing drugged driving is wrongly based on the model of 0. 08 g/d. L BAC Obscures the fact that many drivers are significantly impaired at levels well below 0. 08 BAC Tolerance and consumption effects vary among alcohol users displaying widely varying degrees of impairment at 0. 08 BAC or higher Though cases are much more difficult to try, impaired drivers under 0. 08 BAC can be prosecuted Most Western European countries use 0. 05 g/d. L limit; Sweden and Norway use 0. 02 g/d. L limit (Du. Pont, et al. , 2013)
Mirage of BAC Equivalent for Drugs Alcohol is a poor model for studying impairing effects of drugs; metabolized in simpler ways than drugs No close link between blood or other levels of a drug (or drug metabolites) and measured impairments Vast number of potentially impairing drugs Drug-drug, drug-alcohol combinations Emergence of synthetic “designer” drugs (Reisfield, et al. , 2012; Du. Pont, et al. , 2013)
Mirage of BAC Equivalent for Drugs Role of tolerance in impairment: e. g. methadone Consumption of 50 mg of methadone can be lethal to person who has not used opioids in prior few weeks or months Chronic administration of methadone at stable doses typically produces no measurable impairment at higher doses Others factors on impairment include time of day, driver age and driver experience (Reisfield, et al. , 2012; Du. Pont, et al. , 2013)
The Bottom Line Setting impairment thresholds based on tissue levels of drugs or metabolites for illegal drugs is not a viable enforcement option 0. 08 BAC equivalent is not needed We have abundant successful precedents for using the per se standard for drugs of abuse (Reisfield, et al. , 2012; Du. Pont, et al. , 2013)
Per Se Drug Laws Under a per se drug law, any identified illegal drug level found in a driver is defined as a drugged driving violation Modeled on the successful per se drug program used for the 10 million American commercial drivers and others in safety-sensitive positions In the United States, drivers under age 21 are held to a zero tolerance per se standard for alcohol (Walsh, 2009; Du. Pont, et al. , 2012)
The Bright Line of Illegality For drivers arrested for impaired driving: When the drug use is illegal, the zero tolerance per se standard is used When the drug use is legal (e. g. prescription drug for which the driver has a valid prescription), the “impairment” standard is used (Voas, et al. , 2013; Du. Pont, et al. , 2012)
Impairment Laws Impairment is a hard case to make without per se law but it can be done Drivers can be prosecuted for impaired driving when they are under 0. 08 BAC alcohol Remember that it is illegal to drive impaired with no alcohol and no drugs (Du. Pont, et al. , 2012)
Complexity of Marijuana This is a political complexity; not a scientific complexity A solution: When marijuana use is “legal”, use the impairment standard When marijuana use is illegal, use the zero tolerance per se standard Caveat: Marijuana is illegal throughout the U. S. under federal law The two wild cards are state-based “medical marijuana” and legal marijuana in Colorado and Washington which will have to be settled by the U. S. Supreme Court
Policy Focus on Marijuana State-based marijuana policy changes have ignited a renewed focus on finding a BAC equivalent for marijuana with recommendations between 2 ng/m. L and 10 ng/m. L THC in whole blood Large study of drivers arrested for impairment in Sweden over 10 years tested between 30 -90 minutes after arrest: 90% had THC concentrations below 5 ng/m. L in blood 61% had THC concentrations below 2 ng/m. L in blood 43% had THC concentrations below 1 ng/m. L in blood (Jones, Holmgren, & Kugelberg, 2008)
Frequency Distribution of Blood THC Concentrations Among DUI Suspects Under a 5 ng/m. L THC limit for blood, only 10% of drivers in this study would have been prosecuted (Jones, Holmgren, & Kugelberg, 2008)
Washington and Colorado Washington has a 5 ng/ml THC per se limit for blood Any driver at or over 5 ng/ml is in violation Colorado has a 5 ng/ml permissible inference limit for blood – weakest drugged driving law for marijuana Inference that any driver at or over 5 ng/ml was under the influence at time of arrest but impairment must be proved 70% of Colorado drivers arrested for suspicion of driving under the influence who test positive for active THC test at less than 5 ng/ml Both 5 ng/ml limits – per se and permissible inference – give free passes for most stoned drivers (Wood, 2013)
Latest Marijuana Research Recent smoking and/or blood THC concentrations of 2 -5 ng/m. L are associated with substantial driving impairment Epidemiological research suggests that marijuana use doubles risk of motor vehicle crash Whole blood THC concentrations persist multiple days after drug discontinuation in heavy chronic marijuana users After 3 weeks of abstinence, chronic daily marijuana users showed observable impairment compared to occasional marijuana users (Li, et al 2012; Asbridge, et al. 2012; Hartman & Huestis 2013; Karschner et al. 2009; Bosker et al. 2013)
Role of the Pro-Drug Lobby Advocates for permissive drug policies aim to legalize the use, production and sale of drugs, beginning with marijuana “Medical marijuana” movement has been successful in shifting the lobby’s goal to full marijuana legalization “Psychedelic medicine” is the next candidate for drug legalization Pro-drug lobby opposes driving restrictions on drug users – particularly against laws related to marijuana
Administrative License Revocation Non-criminal penalty system used today to get drunk drivers off the road quickly ALR process begins after arrest for impairment is made Loss of license for drivers who test at or above 0. 08 BAC alcohol ALR for drugs is the next step in drugged driving enforcement Presumption of innocence is preserved for later adjudication of criminal charge of DUI or DUID by a judge (National Transportation Board, 2013)
Importance of ALR is a potential game-changer because it would bring drug testing to the police station in a way parallel to alcohol testing Use of on-site oral fluid or urine testing Loss of license for positive screening drug test results Laboratory confirmation of positive tests prior to adjudication
Typical Testing Procedures In the U. S. impairment is determined prior to arrest Use of Standardized Field Sobriety Tests (SFSTs) Some states use Drug Recognition Experts (DREs) Specimen testing typically occurs after arrest When illegal BAC is found, testing usually ends and driver is charged with drunk driving If an impaired driver has a low BAC then drug testing should but does not always occur
Improve Drug Testing Procedures Use on-site screening tests for ALL impaired driving suspects, including those who have illegal BACs Testing technology has improved; oral fluid testing permits easy specimen collection and initial screening results but today few states permit its use Laboratory confirmation Address laboratory staff/funding issues Drivers who have illegal BACs and test positive for drugs should be charged with an aggravated offense, like drivers with high BACs (≥ 0. 15 g/d. L)
Other Drug Testing Opportunities Drivers in crashes causing serious injuries or death, either at the scene or at the hospital/trauma center When drugs have been found in vehicles or on drivers When drivers admit to recent drug use Highway security checkpoints
Education, Training & Treatment Incorporate drugged driving into drivers’ education and substance abuse prevention programs Educate groups at higher risk about drugged driving, e. g. Drug Court participants Increased training to law enforcement on identifying drugged drivers Screen and refer drugged drivers to treatment and appropriate monitoring programs to reduce recidivism
DUI Offender Management Assess DUI offenders for both alcohol and drug use problems and other disorders Ensure all DUI offenders are tested for alcohol and drugs Close monitoring after conviction using model programs that stop alcohol and drug use rather than focusing exclusively on driving behaviors
DWI/Drug Courts Manage hardcore repeat impaired driving offenders Leverage criminal justice system to improve longterm outcomes including reduced recidivism Focus on accountability and long-term treatment Address other issues including mental health problems (Fell, et al. , 2011; Hiller, et al, 2009; Michigan SCAO, 2008)
DWI/Drug Courts Frequent random drug and alcohol testing with immediate consequences Great potential resource to address drugged drivers Consider prominent overlap of drug problems among alcohol-impaired drivers (Fell, et al. , 2011; Hiller, et al, 2009; Michigan SCAO, 2008)
Education Within DWI/Drug Courts Participants in both DWI Courts and Drug Courts need to be educated about the risks of drugged driving Remind them that it is unsafe – and illegal – to drive under the influence of alcohol and after using drugs Place special emphasis on marijuana which many people do not recognize as a highway safety threat
24/7 Sobriety Program • Focuses on keeping DUI offenders abstinent from alcohol and drugs • Treatment and 12 -Step involvement is optional • Frequent alcohol and drug testing: • Twice daily alcohol breath tests (7 AM & 7 PM) or • SCRAM alcohol monitoring ankle bracelets; and • Random drug urinalysis or • Drug patch • Any positive test results in an immediate short-term stay in jail (South Dakota Office of the Attorney General, 2013)
24/7 Sobriety Results 55% never fail a test 16. 7% fail only one test 12. 5% fail only twice 16. 9% fail three or more times DUI recidivism substantially lower among 24/7 participants at 1, 2, and 3 years from program completion (South Dakota Office of the Attorney General, 2012)
Community Impact 24/7 Sobriety has helped reduce: Repeat drunk driving offenses by 12% at the county level Domestic violence by 9% Traffic crashes for males between ages 18 -40 by 4% Frequent random monitoring linked to swift, certain and meaningful consequences – mostly brief incarceration – produces fewer failures (Kilmer, et al. , 2013; Du. Pont, et al. , 2010 )
Next Steps for Drugged Driving Use of administrative license revocation to get drugged drivers immediately off the roads and to increase drug testing of DUI suspects Use of the per se standard to effectively identify and prosecute drugged drivers Ongoing research and evaluation of drugged driving laws and enforcement strategies Focus on the management of the 1. 2 million people arrested for DUI each year
Conclusions Focusing on drugged driving builds upon and enhances efforts to reduce drunk driving; they are synergetic – NOT COMPETITIVE The never-ending search for impairment thresholds derails actions to prevent drugged driving and enforce laws
Conclusions Effective action on drugged driving will achieve 3 important goals: 1) Reduce illegal drug use and reinforce prevention 2) Improve highway safety 3) Provide an important new pathway to treatment and recovery for drug users as drunk driving enforcement now does for individuals with alcohol use problems
Thank you!
www. Stop. Drugged. Driving. org For more information on drugged driving visit IBH’s website devoted to this public health and public safety problem
www. IBHinc. org For more information on other new and important ideas to reduce illegal drug use visit IBH’s home website
References and Resources Asbridge, M. , Hayden, J. A. , & Cartwright, J. L. (2012). Acute cannabis consumption and motor vehicle collision risk: systematic review of observational studies and metaanalysis. British Medical Journal, 344, e 536. Bosker, W. M. , Karschner, E. L. , Lee, D. , Goodwin, R. S. , Hirvonen, J. , Innis, R. B. , Theunissen, E. L. , Kuypers, K. P. , Huestis, M. A. , & Ramaekers, J. G. (2013). Psychomotor Function in Chronic Daily Cannabis Smokers during Sustained Abstinence. PLo. S One, 8(1), e 53127. Center for Substance Abuse Research. (2010, December 20). One-third of fatally injured drivers with known test results tested positive for at least one drug in 2009. CESAR FAX, 19(4). Compton, R. , & Berning, A. (2009, July). Results of the 2007 National Roadside Survey of Alcohol and Drug Use by Drivers. Traffic Safety Facts, Research Note. Washington, DC: National Highway Traffic Safety Administration, National Center for Statistics and Analysis. Couper, F. J. , & Logan, B. K. (2004). Drugs and Human Performance Fact Sheets. Washington, DC: National Highway Traffic Safety Administration. Available: http: //www. nhtsa. gov/People/injury/research/job 185 drugs/index. htm Du. Pont, R. L. , Logan, B. K. , Shea, C. L. , Talpins, S. K. , & Voas, R. B. (2011). Drugged Driving Research: A White Paper. Institute for Behavior and Health, Inc. Drugged Driving Committee. Prepared for the National Institute on Drug Abuse. Available: http: //www. whitehouse. gov/sites/default/files/ondcp/issues-content/druggeddriving/nida_dd_paper. pdf
Du. Pont, R. L. , Reisfield, G. M. , Goldberger, B. A. , & Gold, M. S. (2013). The Seductive Mirage of a 0. 08 g/d. L BAC Equivalent for Drugged Driving. DATIA Focus, 6(1), 36 -43. Du. Pont, R. L. , Shea, C. L. , Talpins, S. K. , & Voas, R. (2010). Leveraging the criminal justice system to reduce alcohol- and drug-related crime. The Prosecutor, 44(1), 38 -42. Du. Pont, R. L. , Voas, R. B. , Walsh, J. M. , Shea, C. , Talpins, S. K. , & Neil, M. M. (2012). The need for drugged driving per se laws: A commentary. Traffic Injury Prevention, 13(1), 3142. Fell, J. C. , Tippetts, A. S. , & Langston, E. A. (2011). An Evaluation of Three Georgia DUI Courts. DOT HS 811 450. Washington, DC: National Highway Traffic Safety Administration. Available: http: //www. dwicourts. org/sites/default/files/nadcp/Georgia%20 Final%20 Study. pdf Hartman RL, Huestis MA. (2013). Cannabis Effects on Driving Skills. Clinical Chemistry, 59(3), 478 -492. Hiller, M. , Saum, C. , Taylor, L. , et al. , (2009). Waukesha Alcohol Treatment Court (WATC): Process and Outcomes. Philadelphia, PA: Temple University. Available: http: //www. dwicourts. org/sites/default/files/nadcp/WATC_Outcome_Evaluationfinal%20 draft. pdf Jones, A. W. , Holmgren, A. , & Kugelberg, F. C. (2008). Driving under the influence of cannabis: A 10 -year study of age and gender differences in the concentrations of tetrahydrocannabinol in blood. Addiction, 103(3), 452 -461 Karschner EL, Schwilke EW, Lowe RH, Darwin WD, Pope HG, Herning R, Cadet JL, Huestis MA. (2009). Do Delta 9 -tetrahydrocannabinol concentrations indicate recent use in chronic cannabis users? Addiction, 104(12): 2041 -8.
Kilmer, B. , Nicosia, N. , Heaton, P. & Midgette, G. (2013). Efficacy of frequent monitoring with swift, certain and modest sanctions for violations: Insights from South Dakota’s 24/7 Sobriety Project. American Journal of Public Health, 103(1), e 37 -e 43. Lacey, J. H. , Kelley-Baker, T. , Furr-Holden, D. , Voas, R. B. , Romano, E. , et al. (2009). 2007 National Roadside Survey of Alcohol and Drug Use by Drivers: Drug Test Results. DOT HS 811 249. Washington, DC: National Highway Traffic Safety Administration. Available: http: //www. nhtsa. gov/Driving+Safety/Research+&+Evaluation/2007+National+Roadsid e+Survey+of+Alcohol+and+Drug+Use+by+Drivers Li, G. , Brady, J. E. , & Chen, Q. (2013). Drug use and fatal motor vehicle crashes: A casecontrol study. Accident; Analysis and Prevention, 60, 205 -210. Li, M. , Brady, J. E. , Di. Maggio, C. J. , Lusardi, A. R. , Tzong, K. Y. , & Li, G. (2012). Marijuana use and motor vehicle crashes. Epidemiologic Reviews, 34(1), 65 -72. Michigan Superior Court Administrative Office & NPC Research. (2008). Michigan DUI Courts Outcome Evaluation. Lansing, MI: Michigan Superior Court Administrative Office. Available: http: //www. dwicourts. org/sites/default/files/nadcp/MI%20 DUI%20 Outcome%20 Evalu ation%20 FINAL%20 REPORT%20 Re-Release%20 March%202008_0. pdf National Highway Traffic Safety Administration. (2010, November). Drug Involvement of Fatally Injured Drivers. Traffic Safety Facts. DOT HS 811 415 Washington, DC: NHTSA’s National Center for Statistics and Analysis. Available: http: //wwwnrd. nhtsa. dot. gov/Pubs/811415. pdf National Transportation Safety Board. (2013). Reaching Zero: Actions to Eliminate Alcohol-Impaired Driving. Safety Report NTSB/SR-13/01. Washington, DC: National Transportation Safety Board. Available: http: //www. ntsb. gov/doclib/reports/2013/SR 1301. pdf
Office of National Drug Control Policy. (2010). National drug control strategy, 2010. Washington, DC: Office of National Drug Control Policy. Available: http: //www. whitehouse. gov/sites/default/files/ondcp/policy-and-research/ndcs 2010. pdf Office of National Drug Control Policy. (2011 a). National drug control strategy, 2011. Washington, DC: Office of National Drug Control Policy. Available: http: //www. whitehouse. gov/sites/default/files/ondcp/ndcs 2011. pdf Office of National Drug Control Policy. (2011 b, October 13). White House drug policy director and Mothers Against Drunk Driving unite to combat drugged driving; call on parents to act to reduce significant public safety threat. Washington, DC: ONDCP Public Affairs. Available: http: //www. whitehouse. gov/sites/default/files/ondcp/white_house_drug_policy_direct or_and_mothers_against_drunk_driving_unite_to_combat_drugged_driving. pdf Office of National Drug Control Policy. (2012). National drug control strategy, 2012. Washington, DC: Office of National Drug Control Policy. Available: http: //www. whitehouse. gov/sites/default/files/ondcp/2012_ndcs. pdf Reisfield, G. M. , Goldberger, B. A. , Gold, M. S. , & Du. Pont, R. L. (2012). The mirage of impairing drug concentration thresholds: A rationale for zero tolerance per se driving under the influence of drugs laws. Journal of Analytical Toxicology, 36(5), 353 -356. Romano, E. , & Pollini, R. A. (2013). Patterns of drug use in fatal crashes. Addiction, 108(8), 1428 -1438. Romano, E. , & Voas, R. B. (2011). Drug and alcohol involvement in four types of fatal crashes. Journal of Studies on Alcohol and Drugs, 72(4), 567 -576. Schwilke, E. W. , Sampaio dos Santos, M. I. , & Logan, B. K. (2006). Changing patterns of drug and alcohol use in fatally injured drivers in Washington State. Journal of Forensic Science, 51(5), 1191 -1198.
South Dakota Office of the Attorney General. (2013). South Dakota 24/7 Program. Available: http: //apps. sd. gov/atg/dui 247/247 ppt. pdf (retrieved November 2013 Substance Abuse and Mental Health Services Administration. (2013). Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-46, HHS Publication No. (SMA) 13 -4795. Rockville, MD: Substance Abuse and Mental Health Services Administration. Voas, R. B. , Du. Pont, R. L. , Shea, C. L. , & Talpins, S. K. (2013). Prescription drugs, drugged driving and per se laws. Injury Prevention, 19(3), 218 -221. Voas, R. B. , Du. Pont, R. L. , Talpins, S. K. & Shea, C. L. (2011). Towards a national model for managing impaired driving offenders. Addiction, 106(7), 1221 -1227. Walsh, J. M. (2009). A State-by-State Analysis of Laws Dealing with Driving Under the Influence of Drugs. Washington, DC: National Highway Traffic Safety Services Administration. DOT HS 811 236. Walsh, J. M. , Flegel, R. , Atkins, R. , Cangianelli, L. A. , Cooper, C. , Welsh, C. , & Kerns, T. J. (2005). Drug and alcohol use among drivers admitted to a Level-1 trauma center. Accident Analysis & Prevention, 37(5), 894 -901. Wood, E. (2013, January 1). Should Colorado adopt a permissible limit for THC? No. Denver Post. Available: http: //www. denverpost. com/opinion/ci_22351390/no-allowing-5 -ng-limit-thc-lev
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